Fertility after uterine artery embolization of fibroids

a systematic review

Publikation: Bidrag til tidsskriftReviewForskningpeer review

Resumé

PURPOSE: The impact of uterine artery embolization (UAE) for the purpose of diminishing the effect of uterine fibroids on fertility is unclear. We have investigated the reported rates of pregnancy and miscarriage after treatment of uterine fibroids with UAE.

MATERIALS AND METHODS: We searched for relevant information in PubMed and Embase for randomized controlled trials (RCT), controlled clinical trials, comparative before-after trials, cohort studies, case-control studies and case series where UAE treatment of premenopausal women was performed for uterine fibroids with and where a control intervention was included. The PRISMA guideline was used to do a systematic review using the main outcomes pregnancy rate and miscarriage rate. Risk of bias was assessed by the Cochrane risk of bias tool or by ROBINS-I. The quality of evidence was assessed by the GRADE approach.

RESULTS: We included 17 studies (989 patients): 1 RCT, 2 cohort studies, and 14 case series. Pregnancy rates after UAE were 50% in the RCT and 51 and 69% in the cohort studies. Among the case series median pregnancy rate was 29%. Miscarriage rates were 64% in the RCT. Miscarriage rates at 56 and 34% were found in the cohort studies after UAE. The median miscarriage rate was 25% in the case series.

CONCLUSION: Pregnancy rate was found to be lower and miscarriage rate higher after UAE than after myomectomy. However, we found very low quality of evidence regarding the assessed outcomes and the reported proportions are uncertain. There is a need for improved prospective randomized studies to improve the evidence base. Systematic review registration number: CRD42016036661.

OriginalsprogEngelsk
TidsskriftArchives of Gynecology and Obstetrics
Vol/bind297
Udgave nummer1
Sider (fra-til)13–25
ISSN0932-0067
DOI
StatusUdgivet - jan. 2018

Fingeraftryk

Uterine Artery Embolization
Leiomyoma
Spontaneous Abortion
Cohort Studies
Randomized Controlled Trials
Controlled Clinical Trials
PubMed
Case-Control Studies
Prospective Studies
Guidelines

Citer dette

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title = "Fertility after uterine artery embolization of fibroids: a systematic review",
abstract = "PURPOSE: The impact of uterine artery embolization (UAE) for the purpose of diminishing the effect of uterine fibroids on fertility is unclear. We have investigated the reported rates of pregnancy and miscarriage after treatment of uterine fibroids with UAE.MATERIALS AND METHODS: We searched for relevant information in PubMed and Embase for randomized controlled trials (RCT), controlled clinical trials, comparative before-after trials, cohort studies, case-control studies and case series where UAE treatment of premenopausal women was performed for uterine fibroids with and where a control intervention was included. The PRISMA guideline was used to do a systematic review using the main outcomes pregnancy rate and miscarriage rate. Risk of bias was assessed by the Cochrane risk of bias tool or by ROBINS-I. The quality of evidence was assessed by the GRADE approach.RESULTS: We included 17 studies (989 patients): 1 RCT, 2 cohort studies, and 14 case series. Pregnancy rates after UAE were 50{\%} in the RCT and 51 and 69{\%} in the cohort studies. Among the case series median pregnancy rate was 29{\%}. Miscarriage rates were 64{\%} in the RCT. Miscarriage rates at 56 and 34{\%} were found in the cohort studies after UAE. The median miscarriage rate was 25{\%} in the case series.CONCLUSION: Pregnancy rate was found to be lower and miscarriage rate higher after UAE than after myomectomy. However, we found very low quality of evidence regarding the assessed outcomes and the reported proportions are uncertain. There is a need for improved prospective randomized studies to improve the evidence base. Systematic review registration number: CRD42016036661.",
keywords = "Abortion, Spontaneous, Cohort Studies, Female, Fertility, Humans, Infertility/etiology, Leiomyoma/therapy, Pregnancy, Pregnancy Rate, Randomized Controlled Trials as Topic, Treatment Outcome, Uterine Artery Embolization/adverse effects, Uterine Myomectomy, Uterine Neoplasms/therapy, Pregnancy rate, Miscarriage rate, Uterine fibroids, Uterine artery embolization",
author = "K Karlsen and A Hrobjartsson and M Korsholm and O Mogensen and P Humaidan and P Ravn",
year = "2018",
month = "1",
doi = "10.1007/s00404-017-4566-7",
language = "English",
volume = "297",
pages = "13–25",
journal = "Archives of Gynecology and Obstetrics",
issn = "0932-0067",
publisher = "Heinemann",
number = "1",

}

TY - JOUR

T1 - Fertility after uterine artery embolization of fibroids

T2 - a systematic review

AU - Karlsen, K

AU - Hrobjartsson, A

AU - Korsholm, M

AU - Mogensen, O

AU - Humaidan, P

AU - Ravn, P

PY - 2018/1

Y1 - 2018/1

N2 - PURPOSE: The impact of uterine artery embolization (UAE) for the purpose of diminishing the effect of uterine fibroids on fertility is unclear. We have investigated the reported rates of pregnancy and miscarriage after treatment of uterine fibroids with UAE.MATERIALS AND METHODS: We searched for relevant information in PubMed and Embase for randomized controlled trials (RCT), controlled clinical trials, comparative before-after trials, cohort studies, case-control studies and case series where UAE treatment of premenopausal women was performed for uterine fibroids with and where a control intervention was included. The PRISMA guideline was used to do a systematic review using the main outcomes pregnancy rate and miscarriage rate. Risk of bias was assessed by the Cochrane risk of bias tool or by ROBINS-I. The quality of evidence was assessed by the GRADE approach.RESULTS: We included 17 studies (989 patients): 1 RCT, 2 cohort studies, and 14 case series. Pregnancy rates after UAE were 50% in the RCT and 51 and 69% in the cohort studies. Among the case series median pregnancy rate was 29%. Miscarriage rates were 64% in the RCT. Miscarriage rates at 56 and 34% were found in the cohort studies after UAE. The median miscarriage rate was 25% in the case series.CONCLUSION: Pregnancy rate was found to be lower and miscarriage rate higher after UAE than after myomectomy. However, we found very low quality of evidence regarding the assessed outcomes and the reported proportions are uncertain. There is a need for improved prospective randomized studies to improve the evidence base. Systematic review registration number: CRD42016036661.

AB - PURPOSE: The impact of uterine artery embolization (UAE) for the purpose of diminishing the effect of uterine fibroids on fertility is unclear. We have investigated the reported rates of pregnancy and miscarriage after treatment of uterine fibroids with UAE.MATERIALS AND METHODS: We searched for relevant information in PubMed and Embase for randomized controlled trials (RCT), controlled clinical trials, comparative before-after trials, cohort studies, case-control studies and case series where UAE treatment of premenopausal women was performed for uterine fibroids with and where a control intervention was included. The PRISMA guideline was used to do a systematic review using the main outcomes pregnancy rate and miscarriage rate. Risk of bias was assessed by the Cochrane risk of bias tool or by ROBINS-I. The quality of evidence was assessed by the GRADE approach.RESULTS: We included 17 studies (989 patients): 1 RCT, 2 cohort studies, and 14 case series. Pregnancy rates after UAE were 50% in the RCT and 51 and 69% in the cohort studies. Among the case series median pregnancy rate was 29%. Miscarriage rates were 64% in the RCT. Miscarriage rates at 56 and 34% were found in the cohort studies after UAE. The median miscarriage rate was 25% in the case series.CONCLUSION: Pregnancy rate was found to be lower and miscarriage rate higher after UAE than after myomectomy. However, we found very low quality of evidence regarding the assessed outcomes and the reported proportions are uncertain. There is a need for improved prospective randomized studies to improve the evidence base. Systematic review registration number: CRD42016036661.

KW - Abortion, Spontaneous

KW - Cohort Studies

KW - Female

KW - Fertility

KW - Humans

KW - Infertility/etiology

KW - Leiomyoma/therapy

KW - Pregnancy

KW - Pregnancy Rate

KW - Randomized Controlled Trials as Topic

KW - Treatment Outcome

KW - Uterine Artery Embolization/adverse effects

KW - Uterine Myomectomy

KW - Uterine Neoplasms/therapy

KW - Pregnancy rate

KW - Miscarriage rate

KW - Uterine fibroids

KW - Uterine artery embolization

U2 - 10.1007/s00404-017-4566-7

DO - 10.1007/s00404-017-4566-7

M3 - Review

VL - 297

SP - 13

EP - 25

JO - Archives of Gynecology and Obstetrics

JF - Archives of Gynecology and Obstetrics

SN - 0932-0067

IS - 1

ER -